Healthcare Provider Details

I. General information

NPI: 1730179334
Provider Name (Legal Business Name): CASCADE ORAL & MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W CASCADE WAY SUITE 103
SPOKANE WA
99208-6003
US

IV. Provider business mailing address

101 W CASCADE WAY SUITE 103
SPOKANE WA
99208-6003
US

V. Phone/Fax

Practice location:
  • Phone: 590-468-1535
  • Fax: 509-467-6372
Mailing address:
  • Phone: 590-468-1535
  • Fax: 509-467-6372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateWA

VIII. Authorized Official

Name: DR. JOHN RICHARD AMES
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 509-468-1535